Rabies-transplant prompts questions: How are donated organs screened?

WASHINGTON – A Maryland man’s death from rabies contracted through an organ transplant has raised questions about the screening process for donated organs.

The federal government just issued new guidelines urging doctors to test for rare conditions such as rabies. The guidelines are unrelated to the Maryland case, but local transplant network organizers say there are already safeguards in place to protect recipients against more common viruses and diseases.

“In every instance that involves a potential deceased organ donor, where authorization has been given for donation, extensive medical screening is performed. It’s done to assess the quality of the organs and to identify any risk of disease that might be transmitted through the transplant,” says John Ogden of the Washington Regional Transplant Community.

The group is responsible for identifying and vetting organ donations from those who die within the region.

“If you haven’t registered on your driver’s license, and you pass away in a hospital in the Washington, D.C., area, WRTC will have a discussion with your family about the possibility that you have to become an organ donor. Then, once we receive authorization from that family, we can move forward with the donation if you are a viable candidate,” Ogden says

Registered organ donors have already given consent to donate their organs after death.

There is only a small window of time after death for the organs to be transplanted into a sick patient elsewhere. And a number of tests must be done first to identify any potential risks.

“Tests for viruses such as HIV and hepatitis. But the truth is there are a number of diseases for which rapid results are not available. And since there may be a period of time before lab results indicate an active infection, significant additional information is gathered through what we call a medical social history questionnaire that we ask the family, or people who have knowledge of the donor,” Ogden says.

More than 117,000 people are on a waiting list for organs in the United States. Ogden says about 2,000 of them are in the D.C. area. He says just under half of all adults in the area are registered organ donors.

In addition to managing organ donations, the organ procurement organizations are tasked with getting more people to register as donors, and that includes tackling some myths.

“Only after all efforts have been exhausted to save someone’s life is organ donation even discussed. So it’s really important that people understand that you need to trust the health care professionals, the doctors, the nurses at hospitals because they will work to save your life,” Ogden says.

Because of the dire situation for many people who need transplants, national guidelines leave it to doctors and the specific patient to decide whether to accept organs that may include some risk of infection, if it means survival.

“These are people who will die unless they receive these very vital organ transplants. Thousands more require what are called tissue transplants and these are things like skin grafts that help burn victims prevent fluid loss, infection, dehydration, and save their lives. It’s things like cornea transplants,” Ogden says

“Up to nine lives can be saved through a single organ donor, and 50 to 100 lives can be saved or enhanced through tissue donation,” he adds.

Since the transplant that led to the Maryland man’s death from rabies, the Organ Procurement and Transplantation Network, which is the unified transplant network set up by federal law, has issued new guidelines for the organ procurement organizations to be vigilant for diseases like rabies or West Nile Virus in organ donors. The new guidelines were issued separately from the current case, which did not come to light until this month.

The only other known case of rabies transmitted through an organ transplant in the U.S. was in the South in 2004.